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Current COFA enrollees

COFA citizens are now eligible for the Oregon Health Plan

IMPORTANT: Check your HealthCare.gov account

HealthCare.gov may ask you for documents to verify your income, immigration status, identity, Special Enrollment status, or something else. It’s important that you submit your documents by the HealthCare.gov deadline so you don’t lose your health insurance or your tax credits.

Reimbursement for out-of-pocket costs

The program will reimburse you for allowed in-network out-of-pocket costs up to $900 (individual enrollment) or $1,800 (family enrollment).

To get reimbursed for your out-of-pocket costs, you will need to submit:

  1. COFA program reimbursement claim form
  2. Original receipt of payment from your doctor, pharmacy, or other provider
  3. A copy of your insurance company’s Explanation of Benefits

Please type or clearly print your information into the form, print and then mail or fax (along with a copy of your Explanation of Benefits and your official receipt) to the program:

COFA Premium Assistance Program
Oregon Health Insurance Marketplace
P.O. Box 14480
Salem, OR 97309
Fax: 503-947-0096

Once the program has processed your paperwork for payment, your reimbursement amount will be paid by your choice; check or deposited in a U.S. Bank ReliaCard.  If you choose direct deposit to a  U.S. Bank ReliaCard, and have not yet received one, one will be mailed to you separately; please keep it in a safe place and treat it like cash. If you received a U.S. Bank ReliaCard from a previous enrollment, you will keep and use the same card for future deposits. All your reimbursements will be made in the same manner for the entire year. Please make sure to report address changes to the program.

Learn more about the COFA program ReliaCard:

I’ve submitted my claim. Where’s my reimbursement?

Appeals

If there is an issue with a reimbursement claim you previously submitted, or if you would like to request an eligibility redetermination, fill out and submit the following form and any supporting materials by mail or fax to:

COFA Premium Assistance Program
Oregon Health Insurance Marketplace
PO Box 14480
Salem, OR 97309
Fax: 503-947-0096

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